med sure chapters 20-24 prepu and nclex style

mix What finding by the nurse may indicate that the patient has chronic hypoxia? a) Clubbing of the fingers b) Cyanosis c) Peripheral edema d) Crackles

Clubbing of the fingers Correct Explanation: Clubbing of the fingers is a change in the normal nail bed. It appears as sponginess of the nail bed and loss of the nail bed angle (Fig. 20-6). It is a sign of lung disease that is found in patients with chronic hypoxic conditions, chronic lung infections, or malignancies of the lung (Bickley, 2009). The other signs listed may represent only a temporary hypoxia.

The nurse is assessing the lungs of a patient diagnosed with pulmonary edema. Which of the following would be expected upon auscultation? a) Egophony b) Crackles at lung bases c) Absent breath sounds d) Bronchial breath sounds

Crackles at lung bases Explanation: A patient with pulmonary edema would be expected to have crackles in the lung bases, and possible wheezes. Egophony may occur in patients diagnosed with pleural effusion. Absent breath sounds occurs in pneumothorax. Bronchial breath sounds occur in consolidation, such as pneumonia

mix The nurse is caring for a patient with extensive respiratory disease. Which of the following is a late sign of hypoxia in the patient? a) Hypotension b) Restlessness c) Somnolence d) Cyanosis

Cyanosis Correct Explanation: Cyanosis is a late sign of hypoxia. Hypoxia may cause restlessness and an initial rise in blood pressure that is followed by hypotension and somnolence.

mix The nurse is caring for a client who had a recent laryngectomy. Which of the following is reflected in the nursing plan of care? a) Develop an alternate method of communication. b) Encourage oral nutrition on the second postoperative day. c) Assess the tracheostomy cuff for leaks. d) Maintain the client in a low-Fowler's position.

Develop an alternate method of communication. Correct Explanation: The client with a total laryngectomy is not able to speak. Communication needs to be established using an alternate method. The client typically has difficulty with swallowing due to edema in the immediate postoperative period. Alternate forms of nutrition are used. The tracheostomy cuff is often deflated for periods of time. The head of the bed is maintained in a semi-Fowler's position to decrease edema.

The nurse is assisting a physician with an endotracheal intubation for a client in respiratory failure. It is most important for the nurse to assess for: a) Symmetry of the client's chest expansion b) Tracheal cuff pressure set at 30 mm Hg c) Cool air humidified through the tube d) A scheduled time for deflation of the tracheal cuff

Symmetry of the client's chest expansion Correct Explanation: Immediately after intubation, the nurse should check for symmetry of chest expansion. This is one finding that indicates successful endotracheal placement. The tracheal cuff pressure is set between 15 and 20 mm Hg. Routine deflation of the tracheal cuff is not recommended, because the client could then aspirate secretions during the period of deflation. Warm, high, humidified air is administered through the endotracheal tube

A nurse observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude? a) The system is functioning normally. b) The chest tube is obstructed. c) The client has a pneumothorax. d) The system has an air leak.

The system has an air leak. Correct Explanation: Constant bubbling in the water-seal chamber indicates an air leak and requires immediate intervention. The client with a pneumothorax will have intermittent bubbling in the water-seal chamber. Clients without a pneumothorax should have no evidence of bubbling in the chamber. If the tube is obstructed, the fluid would stop fluctuating in the water-seal chamber.

mix The client you are caring for has just been told they have advanced laryngeal cancer. What is the treatment of choice? a) Total laryngectomy b) Partial laryngectomy c) Radiation therapy d) Laser surgery

Total laryngectomy Correct Explanation: In more advanced cases, total laryngectomy may be the treatment of choice. Partial laryngectomy, laser surgery, and radiation therapy are not the treatment of choice for advanced cases of laryngeal cancer

tracheal: duration, intensity, pitch and location

inspiratory and expiratory about same very loud relativey high over the trachea in the neck

bronchovesicular: duration, intensity, pitch and location

inspiratory and expiratory about the same intermediate intermediate often in the 1st and 2nd interspaces anteriorly and between the scapulae (over the main bronchus)

the nurse assesses for which early, most common sign of ARDS

rapid onset of severe dyspnea the acute phase of ARDS is marked by a rapid onset of severe dyspnea that usually occurs less than 72 hours after the precipitating event

tactile fremetisu, percussion, and auscultation patterns for - consolidation (e.g., pneumonia) - bronchitis - emphsema - asthma - pulmonary edema - pleural effusion - pneumothorax - atelectasis

table 20-7 p. 482

Which type of ventilator has a present volume of air to be delivered with each inspiration?

volume-controlled Volume-controlled Correct Explanation: With volume-controlled ventilation, the volume of air to be delivered with each inspiration is present. Negative pressure ventilators exert a negative pressure on the external chest. Time-cycled ventilators terminate or control inspiration after a preset time. When the pressure-cycled ventilator cycles on, it delivers a flow of air (inspiration) until it reaches a present pressure, and then cycles off, and expiration occurs passively.

client is on a positive-pressure ventilator with a synchronized intermittent mandatory ventilation (SIMV) setting. The ventilator is set for 8 breaths per minute. The client is taking 6 breaths per minute independently. The nurse a) Contacts the respiratory therapy department to report the ventilator is malfunctioning b) Continues assessing the client's respiratory status frequently c) Consults with the physician about removing the client from the ventilator d) Changes the setting on the ventilator to increase breaths to 14 per minute

Continues assessing the client's respiratory status frequently Explanation: The SIMV setting on a ventilator allows the client to breathe spontaneously with no assistance from the ventilator for those extra breaths. Data in the stem suggest that the ventilator is working correctly. The nurse would continue making frequent respiratory assessments of the client. There are not sufficient data to suggest the client could be removed from the ventilator. There is no reason to increase the ventilator's setting to 14 breaths per minute or to contact respiratory therapy to report the machine is not working properly. (less)

Stiffness of the neck or inability to bend the neck is referred to as which of the following? a) Aphonia b) Xerostomia c) Dysphagia d) Nuchal rigidity

d) Nuchal rigidity Nuchal rigidity is the stiffness of the neck or inability to bend the neck. Aphonia is impaired ability to use one's voice due to distress or injury to the larynx. Xerostomia is dryness of the mouth from a variety of causes. Dysphagia is difficulty swallowing

the nurse is caring for a client with allergic rhinitis. the patient asks the nurse about measures to help decrease allergic symptoms. the best response by the nurse is ?

* you should try to reduce exposure to irritants and allergens* allergens and irritants include dusts, molds, animals, fuel. odors, powders, sprays and tobacco smoke

what are the signs of acute laryngitis

*hoarsness, aphonia and severe cough* others include a throat that feels worse in the morning. if allergies are present, the uvula will be visibly edematous

strongest predisposing factor for asthma?

allergy

bronchial: duration, intensity, pitch and location

epxiratory longer than inspiratory loud relatively high over manubrium, if heard at all

management of viral rhinitis consists of

symptomatic therapy that includes adequate fluid intake, rest, prevention of chilling, and use of expectorants as needed. warm saltwater gargles soothe the sore throat, and NSAIDS such as aspirin or ibuprofen, relieve aches and pains. *antibiotics are not prescribed because they do not affect the virus causing the patient's signs and symptoms. topical nasal decongestants should be used with caution. the symptoms of viral rhinitis may last from 1-2 weeks

primary symptoms of COPD

three primary symptoms: cough, sputum production and dyspnea on exertion weight loss is common with COPD patients with COPD are at risk for respiratory insufficiency and respiratory infections, which in turn increase the risk of acute and chronic respiratory failure

true or false: in the patient with COPD, fatigue and feeling of exhaustion stem directly from the disease, not from activity level

true

what is important to measure when a patient is taking theophylline and what is this drug used for

used for long-term control and prevention of asthma blood tests to monitor serum concentrations - should be between 5-15 also patient is at risk for developing hypokalemia

a mechanically ventilated patient is receiving an opioid analgesic morphine. the nurse monitors the patient for which potential complication

venous thromoemboli neuromuscular blockers predispose the patient to VTE, muscle atrophy, and skin breakdown. nursing assessment is essential to minimize the complications related to neuromuscular blockade. the patient may have discomfort or pain but be unable to communicate these sensations

which of the following is true about both lung transplant and bullectomy - both are aimed at improving the overall quality of life of a patient with COPD - both are aimed at treating end-stage emphysema - both are used to treat patients with bulls emphysema - both are aimed at curing COPD

- both are aimed at improving the overall quality of life of a patient with COPD lung transplant is aimed at treating end-stage emphysema and bullectoy is used to treat patients with bulls emphysema there is no cure for COPD treatment aimed at treating symptoms and preventing complications, thereby improving the overall qualaity of life of a patient with COPD

The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of a) 3 to 6 months. b) 0 to 3 months. c) 2 to12 days. d) 20 to 30 days.

2 to12 days. Correct Explanation: HSV-1 is transmitted primarily by direct contact with infected secretions. The time period 0 to 3 months exceeds the incubation period. The time period 20 to 30 days exceeds the incubation period. The time period 3 to 6 months exceeds the incubation period.

mix A 6-month-old male client and his elder brother, a 3-year-old male, are being seen in the pediatric clinic for their third middle ear infection of the winter. The mother reports they develop an upper respiratory infection and an ear infection seems quick to follow. What contributes to this event? a) Epiglottis b) Genetics c) Eustachian tubes d) Oropharynx

A 6-month-old male client and his elder brother, a 3-year-old male, are being seen in the pediatric clinic for their third middle ear infection of the winter. The mother reports they develop an upper respiratory infection and an ear infection seems quick to follow. What contributes to this event? You selected: Eustachian tubes Correct Explanation: The nasopharynx contains the adenoids and openings of the eustachian tubes. The eustachian tubes connect the pharynx to the middle ear and are the means by which upper respiratory infections spread to the middle ear. The client's infection is not caused by genetics. The oropharynx contains the tongue. The epiglottis closes during swallowing and relaxes during respiration

mix Constant bubbling in the water seal of a chest drainage system indicates which of the following problems?

Air leak Correct Explanation: The nurse needs to observe for air leaks in the drainage system; they are indicated by constant bubbling in the water seal chamber, or by the air leak indicator in dry systems with a one-way valve. Tidaling is fluctuation of the water level in the water seal that shows effective connection between the pleural cavity and the drainage chamber and indicates that the drainage system remains patent.

The nurse assessed a 28-year-old woman who was experiencing dyspnea severe enough to make her seek medical attention. The history revealed no prior cardiac problems and the presence of symptoms for 6 months' duration. On assessment, the nurse noted the presence of both inspiratory and expiratory wheezing. Based on this data, which of the following diagnoses is likely? a) Adult respiratory distress syndrome b) Acute respiratory obstruction c) Pneumothorax d) Asthma

Asthma Explanation: The presence of both inspiratory and expiratory wheezing usually signifies asthma if the individual does not have heart failure. Sudden dyspnea is an indicator of the other choices. (less)

A nurse is assigned to care for a client with a tracheostomy tube. How can the nurse communicate with this client? a) By suctioning the client frequently b) By providing a tracheostomy plug to use for verbal communication c) By supplying a magic slate or similar device d) By placing the call button under the client's pillow

By supplying a magic slate or similar device Correct Explanation: The nurse should use a nonverbal communication method, such as a magic slate, note pad and pencil, and picture boards (if the client can't write or speak English). The physician orders a tracheostomy plug when a client is being weaned off a tracheostomy; it doesn't enable the client to communicate. The call button, which should be within reach at all times for all clients, can summon attention but doesn't communicate additional information. Suctioning clears the airway but doesn't enable the client to communicate.

A nurse is providing discharge teaching for a client who had a laryngectomy. Which instruction should the nurse include in her teaching? a) "Keep the humidity in your house low." b) "Swimming is good exercise after this surgery." c) "Cover the stoma whenever you shower or bathe." d) "Wear a tight cloth at the stoma to prevent anything from entering it."

Cover the stoma whenever you shower or bathe." Correct Explanation: The nurse should instruct the client to gently cover the stoma with a loose plastic bib, or even a hand, when showering or bathing to prevent water from entering the stoma. The client should cover the stoma with a loose-fitting, not tight, cloth to protect it. The client should keep his house humidified to prevent irritation of the stoma that can occur in low humidity. The client should avoid swimming, because it's possible for water to enter the stoma and then enter the client's lung, causing him to drown without submerging his face.

A client has suspected fluid accumulation in the pleural space of the lungs and is scheduled for a thoracentesis. The nurse will implement which of the following for this procedure? Select all that apply. a) Prepare the client for magnetic resonance imaging after the procedure to verify tube placement. b) Educate the client about the need to cleanse the thoracic area. c) Complete a respiratory assessment after the procedure. d) Place the client in the prone position. e) Apply pressure to the puncture site after the procedure.

Educate the client about the need to cleanse the thoracic area. Complete a respiratory assessment after the procedure. Apply pressure to the puncture site after the procedure. Explanation: A thoracentesis is performed to aspirate fluid or air from the pleural space. The nurse assists the client to a sitting or side-lying position, which provides support and exposes the base of the thorax. Encouraging a position of comfort helps the client to relax for the procedure. The nurse prepares the client by explaining the steps of the procedure and begins by cleansing the thoracic area using aseptic technique. After the procedure, the nurse applies pressure to the site to help stop bleeding; then, he or she applies an air-tight, sterile dressing. A chest x-ray verifies that there is no pneumonthorax. The nurse will monitor at intervals the client's respiratory function.

mix A client stops breathing during sleep as a result of repetitive upper airway obstruction. To help decrease the frequency of the apneic episodes, the nurse intervenes by informing the client to: a) Use nasal oxygen at night. b) Sleep on the back. c) Take a hypnotic medication at hours of sleep. d) Eliminate alcohol ingestion.

Eliminate alcohol ingestion. Correct Explanation: The client's symptoms are consistent with obstructive sleep apnea. Initial treatment includes avoidance of alcohol and hypnotic medications. Clients are told to not sleep on their backs. Administration of nasal oxygen may help with hypoxemia but has little effect on the frequency of apnea. (less)

A client undergoes a total laryngectomy and tracheostomy formation. On discharge, the nurse should give which instruction to the client and family? a) "Limit the amount of protein in the diet." b) "Family members should continue to talk to the client." c) "Oral intake of fluids should be limited for 1 week only." d) "Clean the tracheostomy tube with alcohol and water."

Family members should continue to talk to the client." Correct Explanation: Commonly, family members are reluctant to talk to the client who has had a total laryngectomy and can no longer speak. To promote a supportive environment, the nurse should encourage family members to continue normal communication. The nurse should teach the client to clean the tracheostomy tube with hydrogen peroxide and rinse it with sterile saline solution, to consume oral fluids as desired, and to eat protein-rich foods to promote healing. (l

Your client is scheduled for a bronchoscopy to visualize the larynx, trachea, and bronchi. What precautions would you recommend to the client before the procedure? a) Abstain from food for at least 6 hours before the procedure. b) Avoid atropines as they dry the secretions. c) Practice holding the breath for short periods. d) Avoid sedatives or narcotics as they depress the vagus nerve.

For at least 6 hours before bronchoscopy, the client must abstain from food or drink to decrease the risk of aspiration. Risk is increased because the client receives local anesthesia, which suppresses the reflexes to swallow, cough, and gag. The client receives medications before the procedure. Typically, atropine is given to dry secretions and a sedative or narcotic is given to depress the vagus nerve. The client may need to hold his or her breath for short periods during lung scans and for bronchoscopy.

a 76 year old man presents to the ED complaining of "laryngitis". The triage nurse should ask if the patient has a history of which of the following - GERD - COPD - CHF - RF

GERD laryngitis in the older adults is common and may be secondary to GERD. older adults are more likely to have impaired esophageal peristalsis and a weaker esophageal sphincter. COPD, CHF and RF are not associated with laryngitis in the older adult

A nurse is providing instructions for the client with chronic rhinosinusitis. The nurse accurately tells the client: a) Do not perform saline irrigations to the nares. b) Caffeinated beverages are allowed. c) Sleep with the head of bed elevated. d) You may drink 1 glass of alcohol daily.

General nursing interventions for chronic rhinosinusitis include teaching the client how to provide self-care. These measures include elevating the head of the bed to promote sinus drainage. Caffeinated beverages and alcohol may cause dehydration. Saline irrigations are used to eliminate drainage from the sinus

mix A home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition? a) Semiconsciousness b) Hyperventilation c) Hypoxia d) Delirium

Hypoxia Correct Explanation: As the respiratory center in the brain becomes depressed, hypoxia occurs, producing wheezing, bradycardia, and a decreased respiratory rate. Delirium is a state of mental confusion characterized by disorientation to time and place. Hyperventilation (respiratory rate greater than that metabolically necessary for gas exchange) is marked by an increased respiratory rate or tidal volume, or both. Semiconsciousness is a state of impaired consciousness characterized by limited motor and verbal responses and decreased orientation.

A nurse is concerned that a client may develop postoperative atelectasis. Which nursing diagnosis would be most appropriate if this complication occurs? a) Impaired spontaneous ventilation b) Ineffective airway clearance c) Impaired gas exchange d) Decreased cardiac output

Impaired gas exchange Airflow is decreased with atelectasis, which is a bronchial obstruction from collapsed lung tissue. If there is an obstruction, there is limited or no gas exchange in this area. Impaired gas exchange is thus the most likely nursing diagnosis with atelectasis. (less)

The nurse is caring for a client with a new tracheostomy. Which of the following nursing diagnoses are priorities? Select all that apply. a) Ineffective Airway Clearance related to increased secretions b) Knowledge Deficit related to care of the tracheostomy tube and surrounding site c) Risk for Infection related to operative incision and tracheostomy tube placement d) Impaired Gas Exchange related to shallow breathing and anxiousness

Ineffective Airway Clearance related to increased secretions Impaired Gas Exchange related to shallow breathing and anxiousness Explanation: The client with a new tracheostomy tube has increased secretions, which may become dried and occlude the airway or plug the airway requiring frequent suctioning. Impaired Gas Exchange is an equally important diagnosis. These are related to airway and breathing and are priorities.

Select the nursing diagnosis that would warrant immediate health care provider notification. a) Deficient fluid volume related to decreased fluid intake and increased fluid loss secondary to diaphoresis associated with a fever b) Deficient knowledge regarding prevention of upper airway infections, treatment regimens, the surgical procedure, or postoperative care c) Acute pain related to upper airway irritation secondary to an infection d) Ineffective airway clearance related to excessive mucus production secondary to retained secretions and inflammation

Ineffective airway clearance related to excessive mucus production secondary to retained secretions and inflammation

For a client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the care plan? a) Maintaining continuous bubbling in the water-seal chamber b) Keeping the collection chamber at chest level c) Stripping the chest tube every hour d) Measuring and documenting the drainage in the collection chamber

Measuring and documenting the drainage in the collection chamber Correct Explanation: The nurse should regularly measure and document the amount of chest tube drainage to detect abnormal drainage patterns, such as may occur with a hemorrhage (if excessive) or a blockage (if decreased). Continuous bubbling in the water-seal chamber indicates a leak in the closed chest drainage system, which must be corrected. The nurse should keep the collection chamber below chest level to allow fluids to drain into it. The nurse shouldn't strip chest tubes because doing so may traumatize the tissue or dislodge the tube.

Which of the following terms is used to describe the inability to breathe easily except in an upright position? a) Dyspnea b) Hypoxemia c) Hemoptysis d) Orthopnea

Orthopnea Patients with orthopnea are placed in a high Fowler's position to facilitate breathing. Dyspnea refers to labored breathing or shortness of breath. Hemoptysis refers to expectoration of blood from the respiratory tract. Hypoxemia refers to low oxygen levels in the blood.

A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? a) Partial pressure of arterial oxygen (PaO2) b) Partial pressure of arterial carbon dioxide (PaCO2) c) Bicarbonate (HCO3-) d) pH

Partial pressure of arterial oxygen (PaO2) Correct Explanation: The most significant and direct indicator of the effectiveness of oxygen therapy is the PaO2 value. Based on the PaO2 value, the nurse may adjust the type of oxygen delivery (cannula, Venturi mask, or mechanical ventilator), flow rate, and oxygen percentage. The other options reflect the client's ventilation status, not oxygenation. The pH, HCO3-, and PaCO2 (less)

mix A 42-year-old female client is scheduled for endotracheal intubation prior to her surgery. Which of the following can the nurse instruct this client? a) "The ET tube will be connected to a negative-pressure ventilator." b) "The ET tube will remain in place for at least a day postsurgery." c) "The ET tube will be inserted through an opening in your trachea." d) "The ET tube will maintain your airway while you're under anesthesia."

The ET tube will maintain your airway while you're under anesthesia." Correct Explanation: An endotracheal tube provides a patent airway for clients who cannot maintain an adequate airway on their own. Tracheostomy tubes are inserted into a surgical opening in the trachea, called a tracheotomy. Clients receiving endotracheal intubation for the purpose of general anesthesia should not require long-term placement of the ET tube. Positive-pressure ventilators require intubation and are used for clients who are under general anesthesia. They are also used for clients with acute respiratory failure, primary lung disease, or comatose.

A nurse assesses a client's respiratory status. Which observation indicates that the client is having difficulty breathing? a) Use of accessory muscles b) Controlled breathing c) Diaphragmatic breathing d) Pursed-lip breathing

Use of accessory muscles Explanation: The use of accessory muscles for respiration indicates the client is having difficulty breathing. Diaphragmatic and pursed-lip breathing are two controlled breathing techniques that help the client conserve energy.

after lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes? a) Water-seal chamber b) Air-leak chamber c) Suction control chamber d) Collection chamber

Water-seal chamber Correct Explanation: Fluctuations in the water-seal compartment are called tidal movements and indicate normal function of the system as the pressure in the tubing changes with the client's respirations. The air-leak meter — not chamber — detects air leaking from the pleural space. The collection chamber connects the chest tube from the client to the system. Drainage from the tube drains into and collects in a series of calibrated columns in this chamber. The suction control chamber provides the suction, which can be controlled to provide negative pressure to the chest

mix While auscultating the lungs of a client with asthma, the nurse hears a continuous, high-pitched whistling sound on expiration. The nurse will document this sound as which of the following? a) Wheezes b) Pleural friction rub c) Rhonchi d) Crackles

While auscultating the lungs of a client with asthma, the nurse hears a continuous, high-pitched whistling sound on expiration. The nurse will document this sound as which of the following? You selected: Wheezes Correct Explanation: Wheezes, usually heard on expiration, are continuous, musical, high pitched, and whistle-like sounds caused by air passing through narrowed airways. Often, wheezes are associated with asthma

A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? a) A disconnected ventilator tube b) An ET cuff leak c) A change in the oxygen concentration without resetting the oxygen level alarm d) Kinking of the ventilator tubing

You selected: Kinking of the ventilator tubing Correct Explanation: Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing, bronchospasm, pulmonary embolus, mucus plugging, water in the tube, and coughing or biting on the ET tube. The alarm may also be triggered when the client's breathing is out of rhythm with the ventilator. A disconnected ventilator tube or an ET cuff leak would trigger the low-pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm, not the high-pressure alarm

emphysema

a category of COPD. impaired oxygen and carbon dioxide exchange results from destruction of the walls of *over-distended alveoli*. emphysema is a pathologic term that describes an abnormal distention of the air spaces beyond the terminal bronchioles and destruction of the walls of the alveoli also, a chronic inflammatory response may induce disruption of the parenchymal tissues. has a clnical outcome of airflow obstruction bronchitis includes presence of cough and sputum production for at least a combined of 2-3 months in each of 2 consecutive years bronchiectasis is a condition of chronic dilation of a bronchus or bronchi asthma has a

nurse caring for patient following tonsillectomy and adenoidectomy. two hours after procedure, patient begins to vomit large amounts of dark blood in frequent intervals and is tachycardia and febrile. what should nurse do

after notifying the surgeon, nurse should obtain a light, mirror, gauze, curved hemostats

lung changes in the elderly - what happens to - airway - diameter of alveolar ducts - collagen of alveolar walls - thickness of alveolar membranes - elasticity of alveolar sacs

airway size decreases diameter of alveolar ducts increases increased collagen of alveolar walls increased thickness of alveolar membranes decreased elasticity of alveolar sacs

antibiotic of choice utilized in the treatment of ABRS keflex levofloxacin amoxicillin ceftin

amoxicillin (augmentin) antibiotics should be administereds soon as the diagnosis of ABRS is established. amoxicillin is the antibiotic of choice. for patients who are allergic to doxycycline or respiratory quiniolones, such as levofloxacin (levaguin) can be used

which of the following actions is appropriate for the nurse to take when the patient demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery - report the finding to the physician immediately - record the observation - apply a compression dressing to the area - measure the patient's pulse oximetry

apply a compression dressing to the area subcutaneous emphysema is a typical posopterative finding in the patient after chest surgery. during surgery the air within the pleural cavity is expelled though the tissue opening created by the surgical procedure. subcutaneous em physema is absorbed by the body spontaneously after the underlying leak is treated or halted

nurse is caring for patient admitted to the ED with an uncomplicated nasal fracture. nasal packing has been completed. which of the following interventions should the nurse include in the patient's care - apply an ice pack - position patient in side-lying position - restrict fluid intake - apply pressure to the convex of the nose

apply an ice pack following a nasal fracture, the nurse applies ice and encourages the patient to keep the head elevated. the nurse instructs the patient to apply ice packs to the nose to decrease swelling. the packing inserted to stop the bleeding may be uncomfortable and unpleasant, and obstruction of nasal passages by packing forces patient to breathe through the mouth. this causes mouth dryness. mouth rinses help to moisten and reduce unpleasantness

ARF is defined as (lab values)

arterial oxygen tension (Pa02) to less than 50 (hyperemia) increase in arterial carbon dioxide tension (PaC02) to greater than 50 (hypercapnia) arterial pH of less than 7.35

The nurse is caring for a patient diagnosed with pneumonia. The nurse will assess the patient for tactile fremitus by completing which of the following? a) Asking the patient to say "one, two, three" while auscultating the lungs b) Asking the patient to repeat "ninety-nine" as the nurse's hands move down the patient's thorax c) Placing the thumbs along the costal margin of the chest wall and instructing the patient to inhale deeply d) Instructing the patient to take a deep breath and hold it while the diaphragm is percussed

asking the patient to repeat "ninety-nine" as the nurse's hands move down the patient's thorax While the nurse is assessing for tactile fremitus, the patient is asked to repeat "ninety-nine" or "one, two, three," or "eee, eee, eee" as the nurse's hands move down the patient's thorax. The vibrations are detected with the palmar surfaces of the fingers and hands, or the ulnar aspect of the extended hands, on the thorax. The hand or hands are moved in sequence down the thorax. Corresponding areas of the thorax are compared. Asking the patient to say "one, two, three" while auscultating the lungs is not the proper technique for assessing for tactile fremitus. The nurse assesses for anterior respiratory excursion by placing the thumbs along the costal margin of the chest wall and instructing the patient to inhale deeply. The nurse assesses for diaphragmatic excursion by instructing the patient to take a deep breath and hold it while the diaphragm is percussed

A nurse is preparing a client with a pleural effusion for a thoracentesis. The nurse should: a) raise the head of the bed to a high Fowler's position. b) raise the arm on the side of the client's body on which the physician will perform the thoracentesis. c) place the client supine in the bed, which is flat. d) assist the client to a sitting position on the edge of the bed, leaning over the bedside table.

assist the client to a sitting position on the edge of the bed, leaning over the bedside table. Correct Explanation: A physician usually performs a thoracentesis when the client is sitting in a chair or on the edge of the bed, with the legs supported and the arms folded and resting on a pillow or on the bedside table. Raising an arm, lying supine, or raising the head of the bed won't allow the physician to easily access the thoracic cavity.

A nurse prepares to perform postural drainage. How should the nurse ascertain the best position to facilitate clearing the lungs? a) Arterial blood gas (ABG) levels b) Chest X-ray c) Auscultation d) Inspection

auscultation The nurse should assess breath sounds before doing postural drainage to determine the areas that need draining. Inspection, chest X-rays, and ABG levels are all assessment parameters that give good information about respiratory function but aren't necessary to determine lung areas requiring postural drainage.

Which assessment finding puts a client at increased risk for epistaxis? a) Use of a humidifier at night b) Cocaine use c) History of nasal surgery d) Hypotension

b) Cocaine use Using nasally inhaled illicit drugs, such as cocaine, increases the risk of epistaxis (nosebleed) because of the increased vascularity of the nasal passages. A dry environment (not a humidified one) increases the risk of epistaxis. Hypertension, not hypotension, increases the risk of epistaxis. A history of nasal surgery doesn't increase the risk of epistaxis.

which type of chest configuration is typical of the patient with COPD pigeon chest funnel chest flail chest barrel chest

barrel chest - in patients with COPD who have a primary emphysematous component, chronic hyperinflation leads to the "barrel chest" thorax configuration. This configuration results from a more fixed position of the ribs in the inspiratory position (due to hyperinflation) and from loss of lung elasticity. pigeon chest results from a displaced sternum. flail chest results when the ribs are fractured. funnel chest occurs when there is a depression in the lower portion of the sternum; it is associated with marina's syndrome or rockets

patient has undergone laryngectomy. nurse notes evidence of wound breakdown. nurse understands that patient is at high risk for developing which of the following - carotid hemorrhage - pneumonia - pulmonary embolism - dehydration

carotid hemorrhage the carotid artery lies close to the stoma and may rupture from erosion if the wound does not heal properly pulmonary embolism is associated with immobility. dehydration may lead to poor wound healing and breakdown pneumonia is a risk for any postoperative patient

there are three types of chronic pharyngitis. which of following is characterized by numerous swollen lymph follicles on the pharyngeal wall - chronic granular - aphona - hypertrophic - atrophic

chronic granular aphonia is inability to use one's voice atrophic pharyngitis is characterized by membrane that is thin, white, glistening and at times wrinkled hypertrophic pharyngitis is charaxterized by general thickening and congestion of the pharyngeal mucous membranes

which of these signs indicate the presence of a pleural effusion - resonance upon percussion - wheezing upon auscultation - mottling of the skin upon inspection - decreased chest wall excursion upon palpation

decreased chest wall excursion upon palpation - symptoms of pleural effusion are SOB, pain, assumption of a position that decreases pain, absent breaths sounds, decreased fremitus, a dull, flat sound on percussion and decreased chest wall excursion the nurse may also her a friction rub. chest radiography and emptied tomography (CT) scan show fluid in the involved area

vesicular sounds: duration, intensity, pitch and location

duration: I lasts longer than E soft relatively low entire lung field except over upper sternum

Malignancy of the larynx can be a devastating diagnosis. What does a client with a diagnosis of laryngeal cancer require? a) Emotional support b) Family counseling c) Referral for counseling d) Referral for vocational training

emotional support Clients with a malignancy of the larynx require emotional support before and after surgery and help in understanding and choosing an alternative method of speech. It does not require a referral for counseling or vocational training. It also does not require family counseling

patient who is bleeding profusely from the nose. this is - rhinorrhea - epistaxis - dysphagia - xerostomia

epistaxis xerostomia is dryness of mouth rhinorrhea = drainage of large amount of fluid dysphagia is difficulty swallowing

COPD measures/grades

grade I (mild): FEV: less than or equal to 80% Grade II (moderate): 50-80 grade III (severe): 30-50 grade IV (very severe): less than 30

which of the following measures may increase complications for a patient with COPD - administration of antibiotics - increased oxygen supply - decreased oxygen supply - administration of antitussive agents

increased oxygen supply administrating too much oxygen can result in the retention of carbon dioxide. patients with alveolar hyperventilation cannot increase ventilation to adjust for this increased load, and increasing hypercapnia occurs. all the other measures are aimed at preventing complications.

which type of lung cancer is characterized as fast growing and can arise peripherally - adenocarcinoma - squamous cell carcinoma - bronchoalveolar carcinoma - large cell carcinoma

large cell carcinoma

what are the late complications of radiation therapy

laryngeal necrosis, edema, and fibrosis

a nurse assesses the patient for what most common clinical manifestation of flail chest

paradoxical chest movement

a nurse is caring for a patient after a thoracentesis. which of the following signs if noted in the patient should be reported to physical immediately - oxygen saturation level of 93% - patient is drowsy and complains of headache - patient has subcutaenous emphysema around needle insertion site - patient is becoming agitated and complains of pleuritic pain

patient is becoming agitated and complains of pleuritic pain - after a thoracentesis, the nurse monitors the patient for pneumothorax or recurrence of pleural effusion. signs and symptoms associated with pneumothraax depend on its size and cause. pain is usually sudden and may be pleuritic. the patient may have only minimal respiratory distress with slight chest discomfort and tachypnea with a small simple or uncomplicated pneumothorax. as the pneumothorax enlarges, the patient may become anxious and develop dyspnea with increased use of the accessory muscles

intal (Cromolyn sodium) is CI in who?

patients with acute asthma exacerbation. indications for instal are long-term prevention of symptoms in mild, persistent asthma; it may modify inflammation. int is also preventative treatment prior to exposure to exercise or known allergen provenitl (albuterol), xopenex (levalbuterol HFA), and Atrovent (ipratropium) can be used to relieve acute symptoms

A patient describes his chest pain as knife-like on inspiration. Which of the following is the most likely diagnosis? a) Bronchogenic carcinoma b) Pleurisy c) Bacterial pneumonia d) A lung infection

pleurisy Explanation: Pleuritic pain from irritation of the parietal pleura is sharp and seems to "catch" on inspiration. Some patients describe the pain as being "stabbed by a knife." Chest pain associated with the other conditions may be dull, aching, and persistent.

select all that apply for signs and symptoms of OSA - pulmonary hypotension - loud snoring - polychtemia - evening headaches - insomnia

polychtemia, loud snoring, insomnia signs and symptoms include excessive daytime sleepiness, frequent nocturnal awakening, insomnia, loud snoring, morning headaches, intellectual deterioration, personality changes, irritability, impotence, systemic hypertension, dysrhythmias, pulmonary hypertension, corpulmonale, polychtemia, and enuresis

describe relationship between OSA and polycythemia

polycythemia is characterized by an increase in number of red blood cells and/or the amount of hemoglobin (Hb) per unit volume of blood. the most appropriate hematological parameter for assessment is the hematocrit (HTC). Secondary polycythemia is characterized by increased erythropoiesis stimulating factor (EPO), being normal erythrocyte precursors in the bone marrow. The obstructive sleep apnea syndrome (OSAS) is characterized by intermittent hypoxia occur during sleep and can cause secondary polycythemia.

nurse asking patient to pucker lips to accomplish: (select all that apply) - release trapped air in lungs - condition inspiratory muscles - prevent collapse of the airways - strengthen the diaphragm - control rate and depth of respirations

prevent collapse, control rate and depth, release trapped air pursed-lip breathing helps slow expiration, prevents collapse airways, releases trapped air in the lungs and helps patient control there ate and depth of respirations. this helps patients relax and get control of dyspnea and reduces the feelings of panic they experience. diaphragmatic breathing strengthens the diaphragm during breathing in inspiratory muscle training the patient will be instructed to inhale against a set resistance for a prescribed amount of time every day in order to condition the inspiratory muscles

therapy goals for patient with COPD

provide medicals support for the current exacerbation return the patient to his original functioning abilities, treat the underlying cause of the event * the goal is to have a stable patient with COPD leading the most productive life possible. COPD cannot noisily be cured, but it can be managed so that the patient can live a reasonably normal life. With adequate management, patients should not have to give up their usual activities

which of the following diagnostic tests is used to confirm the diagnosis of maxillary and frontal sinusitis - sinus x rays - MRI - CT scan - sinus aspirates

sinus aspirates to confirm the diagnosis of maxillary and frontal sinusitis and identify the pathogen, sinus aspirates may be obtained. flexible endoscopic culture techniques and swabbing of the sinuses have been used for this purpose sinus X-rays and CT scans may be obtained for patients with frontal headaches, in refractory cases, ad if complications are suspected

the nurse is caring for patient in ICU with a nasotracheal tube. because of the tube placement, nurse understands that the patient is at risk for developing which of the following: - subperiosteal abscess - sinus infection - severe epistaxis - orbital cellulitis

sinus infection patients with nasotrachel and nasogastric tubes in place are at risk for development of sinus infections. thus, accurate assessment of patients with these tubes of critical. removal of nasotracheal or nasogastric tube as soon as patient's condition permits allows the sinuses to drain, possibly avoiding septic complications. severe epistaxis is not a complication of nasotracheal placement. subperiosteal abscess and orbital cellulitis are complications of chronic rhinosinusitis

a patient diagnosed with asthma is preparing for discharge. the nurse is educating the patient on the proper use of a peak flow meter. the nurse would instruct the patient to complete which of the following - sit down while completing a peak flow reading - if coughing occurs during the procedure, repeat it - move the indicator to the top of the numbered scale - take and record peak flow readings three times daily

steps for using the peak flow meter correctly include 1) moving the indicator to the bottom of the numbered scale 2) standing up 3) taking a deep breath and filling the lungs completely 4) placing mouthpiece in mouth and closing lips around mouthpiece 5) blowing out hard and fast with a single blow 6) recording the number achieved on the indicator if the patient coughs or a mistake is made in the process, repeat the procedure peak flow readings should be taken during an asthma attack

Which of the following postoperative instructions does a nurse provide a patient and family to avoid after a laryngeal surgery? a) Hand-held showers b) Swimming c) Coughing d) Wearing a scarf over the stoma

swimming The nurse provides the patient and family with the following postoperative instructions:water should not enter the stoma because it will flow from the trachea to the lungs. Therefore, the nurse instructs the patient to avoid swimming and to use a hand-held shower device when bathing. The nurse also suggests that the patient to wear a scarf over the stoma to make the opening less obvious. The nurse encourages the patient to cough every 2 hours to promote effective gas exchange